Optimizing timing of palliative care referral in platinum resistant ovarian cancer

Abstract

Objectives: An exploration of clinical characteristics, palliative care involvement, and survival in platinum resistant ovarian cancer. Methods: This is a single institution retrospective study of all patients receiving chemotherapy for ovarian, fallopian tube, or peritoneal high-grade carcinoma since 2011. Platinum resistant patients were identified based on chemotherapy regimen or provider definition, then confirmed with clinical data. Data was extracted evaluating platinum resistant treatment, time to progression, and overall survival. Palliative care and hospice referrals were recorded. Descriptive and overall survival analyses were performed. Results: Two hundred and seventy-five platinum resistant patients were identified. Of 100 charts reviewed to date, 78 patients were deceased. The median survival from time of diagnosis of platinum resistant to death was 11.4 months (range 0.5-66 months). Of the 78 deceased patients, 25 (32%) lived less than 6 months from time of diagnosis of platinum resistance (range 0.5-5.9 months), 23 (29.5%) lived 6-12 months, and 30 (38.5%) lived more than 12 months (range 12.9-66 months). Of the 25 patients who lived less than 6 months, 17 (68%) were referred to palliative care and 6 (24%) were referred directly to hospice, 3 of which were within one month of death. Of the 23 patients who lived 6-12 months, 16 (69.5%) were referred to palliative care and 6 (26%) were referred directly to hospice, 5 of which were within one month of death. Finally, of the 30 patients who lived greater than 12 months, 23 (76.7%) were referred to palliative care and 5 (16.7%) were referred directly to hospice. In 17 (57%) of the patients living greater than 12 months after platinum resistance, referral to palliative care or hospice did not happen until the 3 months prior to death (Figure 1). Of the living patients with platinum resistant disease, median survival since diagnosis is 9.8 months. Of these patients, 11 (50%) have been referred to palliative care and 11 (50%) have no documentation of palliative care referral. Data extraction and analysis is on-going, with 175 remaining charts to review. Conclusions: Diagnosis of platinum resistance is a pivotal point in ovarian cancer treatment. Survival from time of diagnosis of platinum resistance to death is limited. National recommendations encourage routine integration of palliative care within eight weeks of diagnosis of advanced cancer in order to optimize patient and caregiver outcomes. Our work found room for improvement in the timing of palliative care referrals in platinum resistant ovarian cancer patients. Even more strikingly, we found a pattern of direct referral to hospice, without palliative care referral prior, often within a month of death. This highlights a significant missed opportunity in utilization of palliative care in the months, and potentially years, leading up to the end of life. Diagnosis of platinum resistance should serve as a stimulus for involvement of palliative care services. Download : Download high-res image (179KB) Download : Download full-size image